Case Presentation Martin Herre

Case Presentation

 Martin Herrera is a 65-year-old male admied to the cardiology unit for a non-ST-elevation myocardial infarction (NSTEMI). It has now been 3 days since Mr. Herrera underwent insertion of a stent; he is preparing for discharge the next day. Prior medical history for Mr. Herrera includes known coronary artery disease, anterior wall myocardial infarction (MI) 2 years earlier, hyperlipidemia, hypertension, and metabolic syndrome. In addition, Mr. Herrera continues to smoke, although he has reduced his smoking to 20 cigarees per day. In preparing Mr. Herrera for discharge, the nurse reviews his discharge medications, medication-taking behavior before admission, and specific cardiovascular disease (CVD) riskreduction strategies (e.g., weight control, exercise, and smoking cessation). Mr. Herrera has admied to not taking his medications on a regular basis, often missing them 2 or 3 days a week. The most common reason given by Mr. Herrera was forgetfulness and “it won’t make a difference anyways.”

To begin the assessment of adherence, it is first important to clarify with the patient (1) his beliefs and perceptions about his health risk status, (2) his existing knowledge about CVD risk reduction, (3) any prior experience with healthcare professionals, and (4) his degree of confidence in being able to control his disease. Clarification of these areas reveals the following: (1) Mr. Herrera believes that because he has a very strong family history of CVD, noting that his father died at age 66 years and his brother at age 60 years, nothing he does will change the final outcome; (2) Mr. Herrera states that he saw a video while in the hospital and was given a bunch of pamphlets, but he does not really remember any specifics; in addition, he has never participated in a smoking cessation program; (3) he is seen by a cardiologist every 12 months, but he did not aend his last appointment because he was told that if he did not quit smoking the cardiologist would transfer him for follow-up by his family physician; and (4) Mr. Herrera states that he tried to quit smoking but was only able to go down to 10 cigarees a day and believes that he is unlikely to be able to smoke any less.

Case Analysis Questions

1. How would you characterize Mr. Herrera’s perception regarding his ability to control his health outcomes? Where would he fit on the scope of adherence (see Fig. 6.1)?

2. What areas should the nurse focus on to improve Mr. Herrera’s motivation for adherence?